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maintain that no real and intelligent friend of Direct Repre-sentation inspired this paragraph of your letter. Thedoctrine involved in it would reduce Direct Representativesto mere voting machines, to receive the last mandate of anyclique of the profession that thought itself a saviour ofsociety and gave its orders to its slaves.

I have a higher conception of Direct Representation. Idid not receive my office on such terms or by the help ofthe group of men-well known and defined-who are at yourback with such degrading and disastrous views of the

principle of Direct Representation which is struggling forextension, not to say for existence. On the contrary, Ireceived it after the honest expression of my views as in thefollowing extract from my address before the election of1896 :-The question of midwives is being clarified by discussion. All are

agreed that the lives of poor women must be guarded from the coarserisks of the perilous ignorance of so-called midwives. While I feel thisvery strongly I am fully alive to the importance of maintaining theprinciple of the Act of 1866 that midwifery is one of the three branchesof the art of medicine, and that those who are not qualified in theother two can only act subordinately to members of the medical pro-fession ; and my endeavour shall be in regard to any legislation withrespect to midwives to secure the clear recognition of this principle.Such are the principles which I have always held, which I

held when asking the votes of the profession, on which I waselected, and which I have done my best to have asserted orinvolved in the Midwives Bill. I should despise myself if,to gain a little temporary praise, I accepted the dictation ofgentlemen who, no doubt, honestly differ from me on themidwives question, but who entirely fail to understand themorality and the strength of Direct Representation. I resentsuch dictation, as a great man did in a larger electoral sphere.He said :-Authoritative dictation, mandates issued which the member is bound

blindly and implicitly to obey, to vote and to argue for, though con-trary to the deepest convictions of his judgment and conscience, theseare things utterly unknown to the laws of this land and which arisefrom a fundamental mistake of the whole order and tenour of ourconstitution.

I abstain here from all discussion of the merits of theMidwives Bill. But in the interest of Direct Representationmore than in my own I am compelled, though very raluct-antly, to write this letter.

Believe me, yours very truly,Dr. F. S. Toogood, Lewisham. J. G. GLOVER.

PS.-I am sending copies of this correspondence toTHE LANCET and the British Medical Journal.

A JOINT COMMITTEE TO OPPOSEMIDWIVES’ REGISTRATION.

THIS committee, which was constituted by resolution ofthe meeting to protest against the Midwives Bill held onApril 4th at the Cannon-street Hotel, and reported in ourissue of April 7th, held a meeting at the Charing-cross Hotelon April 12th, when Mr. GEORGE BROWN took the chair.A "whip" was read, signed by certain Members of Parlia-

ment, to convene a conference at the House of Commons toreceive a deputation of the Joint Committee ; and a draftaddress was approved, subject to modification by theexecutive of the committee, for signature by constituents inboroughs or divisions. This address invited the personalopposition of Members of Parliament to the Midwives Bill,1900, now before Parliament (1) by signing the "whip";(2) by joining the committee ; (3) by promoting deputationsto lay before the Lord President of the Privy Council andthe leader of the House of Commons ; and (4) by opposingin Parliament the adoption of the report upon, and the thirdreading of, the Bill unless amended into the form of usefuland proper provision for the training and registration of mid-wifery nurses not authorised to act in any case as practi-tioners of the art and science of midwifery without medicaleducation and registration.On the motion of Dr. HUGH WOODS, seconded by Dr.

LORIMER HART, the following resolution was unanimouslyadopted :-That the executive be intrusted to take steps with a view to the

requisition of a special general meeting of the British Medical Asso-ciation by members of that association for the object of offering imme-diate opposition to the Midwives Registration Bill.The question of funds was referred to the executive with

nstructions to invite THE LANCET and the British MedicalJournal to open lists.

VITAL STATISTICS.

HEALTH OF ENGLISH TOWNS.

IN 33 of the largest English towns 6802 births and 5120deaths were registered during the week ending April 7th.The annual rate of mortality in these towns, which hadbeen 21-6 and 21-4 per 1000 in the two preceding weeks,further rose during the week to 23’0. In London therate was 22-0 per 1000, while it averaged 23 in the 32provincial towns. The lowest death-rates in these townswere 15 0 in Derby, 16-5 in Birkenhead, 17-2 in Gateshead,and 17 3 in Sunderland; the highest rates were 31’0 inManchester, 31-6 in Liverpool, 32-9 in Preston, and 33-2 inWolverhampton. The 5120 deaths in these towns included500 which were referred to the principal zymotic diseases,against 422, 471, and 497 in the three preceding weeks ;of these 177 resulted from measles, 146 from whooping-cough, 78 from diphtheria, 39 from "fever " (principallyenteric), 30 from scarlet fever, 28 from diarrhoea, and twofrom small-pox. No fatal case of any of these diseasesoccurred in Gateshead; in the other towns they causedthe lowest death-rates in Croydon, Swansea, Derby, andNewcastle ; and the highest rates in Cardiff, Wolver-hampton, Salford, Blackburn, and Preston. The greatestmortality from measles occurred in Plymouth, Cardiff,Wolverhampton, Oldham, Huddersfield, and Halifax ; fromscarlet fever in Nottingham ; and from whooping, cough inWolverhampton, Norwich, Manchester, and Salford. Themortality from "fever" showed no marked excess in anyof the 33 large towns. The 78 deaths from diphtheriaincluded 32 in London, 13 in Sheffield, five in Portsmouth,five in Leeds, and four in Blackburn. Two fatal cases of

small-pox were registered in Liverpool during the weekunder notice, but not one in any other of the 33 towns.There were two small-pox patients under treatment in theMetropolitan Asylums Hospitals on Saturday, April 7th,against numbers declining from 11 to three at the end ofthe six preceding weeks. The number of scarlet feverpatients in these hospitals and in the London Fever Hos-pital at the end of the week was 1713, against numbersdecreasing from 3578 to 1696 on the 20 preceding Saturdays ;185 new cases were admitted during the week, against 181,170, and 172 in the three preceding weeks. Influenza wascertified as the primary cause of 44 deaths in London. Thedeaths referred to diseases of the respiratory organs inLondon, which had increased from 378 to 469 in the fourpreceding weeks, further rose to 499, and were 111 abovethe corrected average. The causes of 75, or 1’5 per cent.,of the deaths in the 33 towns were not certified either bya registered medical practitioner or by a coroner. All thecauses of death were duly certified in West Ham, Cardiff,Bolton, Leeds, and in 10 other smaller towns; the largestproportions of uncertified deaths were registered in Ports-mouth, Liverpool, Preston, Halifax, and Sheffield.

In 33 of the largest English towns 5996 births and 4998deaths were registered during the week ending April 14th.The annual rate of mortality in these towns, which hadbeen 21-4 and 23-0 per 1000 in the two preceding weeks,declined again last week to 22-4. In London the ratewas 21-0 per 1000, while it averaged 23 4 in the 32 pro-vincial towns. The lowest death-rates in these townswere 15-6 in Burnley, 15’8 in West Ham, 16-6 in Sunderland,and 18’2 in Portsmouth ; the highest rates were 28’5 iaLiverpool, 29 0 in Salford, 30 3 in Wolverhampton, and30-5 in Manchester. The 4998 deaths in these townsincluded 477 which were referred to the principalzymotic diseases, against numbers increasing from 442 to500 in the four preceding weeks; of these 182 resulted frommeasles, 144 from whooping-cough, 51 from diphtheria,38 from "fever" (principally enteric), 33 from diarrhoea.27 from scarlet fever, and two from small-pox. The lowestdeath-rates from these diseases occurred last week inBrighton, Birkenhead, Burnley, and Newcastle ; and thehighest rates in Cardiff, Wolverhampton, Oldham, andBlackburn. The greatest mortality from measles occurredin Plymouth, Bristol, Cardiff, and Oldham ; from scarletfever i. Oldham ; from whooping-cough in Wolverhampton,Norwich, Liverpool, and Salford ; and from "fever" inWolverhampton. The 51 deaths from diphtheria included19 in London, seven in Sheffield, four in Leeds, three inBirmingham, and three in Preston. Two fatal cases oî small-

pox were registered last week in Liverpool, but not

one in any other of the 33 large town?. There were

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three cases of small-pox under treatment in the Metro-politan Asylums Hospitals on Saturday last, April 14th,against numbers decreasing from 11 to two at theend of the seven preceding weeks; one new case was

admitted during the week, against none in any of thethree preceding weeks. The number of scarlet fever

patients in these hospitals and in the London Fever

Hospital at the end of the week was 1694, against1696 and 1713 on the two preceding Saturdays; 189 newcases were admitted during the week, against 170, 172, and185 in the three preceding weeks. Influenza was certified asthe primary cause of 42 deaths in London. The deathsreferred to diseases of the respiratory organs in London,which had increased from 378 to 499 in the five precedingweeks, further rose last week to 501, and were 125 above thecorrected average. The causes of 64, or 1-3 per cent., ofthe deaths in the 33 towns were not certified either by aregistered medical practitioner or by a coroner. All thecauses of death were duly certified in Cardiff, Nottingham,Oldham, Bolton, Hull, and seven other smaller towns ; the

largest proportions of uncertified deaths were registered inBirmingham, Liverpool, Blackburn, Preston, Huddersfield,and Sheffield.

___

HEALTH OF SCOTCH TOWNS.

The annual rate of mortality in the eight Scotch towns,which had been 22-2 and 22’8 per 1000 in the two precedingweeks, declined again to 21-7 during the week ending April 7th,and was 1-3 per 1000 less than the mean rate during thesame period in the 33 large English towns. ’ The rates inthe eight Scotch towns ranged from 16’4 in Dundee and 16 -6in Leith to 24 3 in Glasgow and 25-8 in Greenock. The 672deaths in these towns included 19 which were referred todiarrhoea, 15 to whooping-cough, 14 to measles, six to

diphtheria, five to "fever," and four to scarlet fever. Inall 63 deaths resulted from these principal zymotic diseases,against 63, 68, and 75 in the three preceding weeks. These63 deaths were equal to an annual rate of 2’0 per 1000,which was 0’2 per 1000 below the mean rate of the weekfrom the same diseases in the 33 large English towns. Thedeaths from diarrhoea, which had declined from 25 to 14in the four preceding weeks, rose again to 19, of which

eight occurred in Glasgow, three in Edinburgh, three in

Leith, and two in Aberdeen. The fatal cases of whooping-cough, which had increased from 15 to 24, in the three

preceding weeks, declined again to 15, and included 10in Glasgow and three in Aberdeen. The deaths frommeasles, which had been 19 and 14 in the two precedingweeks, were again 14 in the week under notice, nine beingregistered in Glasgow and three in Dundee. The fatal casesof diphtheria, which had been six and 14 in the two pre-ceding weeks, declined again to six, of which three occurredin Glasgow. The deaths referred to different forms of11 fever," which had been four and five in the two pre-ceding weeks, were again five, and included three in

Glasgow. The four fatal cases of scarlet fever corre-

sponded with the number in each of the two precedingweeks, and were all registered in Glasgow. The deathsreferred to diseases of the respiratory organs in thesetowns, which had been 170 and 172 in the two precedingweeks, declined again to 156, but were slightly above thenumber in the corresponding period of last year. Thecauses of 30, or more than 4 per cent., of the deaths inthese eight towns during the week were not certifiedThe annual rate of mortality in the eight Scotch towns,

which had been 22’S and 21’7 per 1000 in the two

preceding weeks, declined again to 21’3 during the weekending April 14th, and was 1’1 1 per 1000 less than the mean rateduring the same period in the 33 large English towns. Therates in the eight Scotch towns ranged from 16’6 in Leithand 18 3 in Aberdeen to 23’3 in Paisley and 40-5 in Perth.The 659 deaths in these towns included 19 which were re-ferred to measles, 19 to diarrhoea, 17 to whooping-cough, ’,four to scarlet fever, four to "fever," and three to diphtheria.In all 66 deaths resulted from these principal zymoticdiseases, against 75 and 63 in the two precedingweeks. These 66 deaths were equal to an annualrate of 2’1 per 1000, which corresponded with the meanrate’ last week from the same diseases in the 33 largeEnglish towns. The deaths from whooping-cough, whichhad been 14 in each of the two preceding weeks, increasedlast week to 19, of which 13 occurred in Glasgow and two in

.Dundee. The fatal cases of diarrhoea, which had been14 and 19 in the two preceding weeks, were again 19 lastweek, and included six in Glasgow, six in Dundee, five inAberdeen, and two in Edinburgh. The deaths irom whooping-cough, which had been 24 and 15 in the two preceding weeks,rose again last week to 17, of which eight were registeredin Glasgow, three in Aberdeen, two in Edinburgh, and twoin Leith. The four fatal cases of scarlet fever coftespondedwith the number in each of the three preceding weeks,and included three in Glasgow. The deaths reterred todifferent forms of "fever," which had been fiva in each ofthe two preceding weeks, declined last week to four, ofwhich three were recorded in Glasgow. The deaths referredto diseases of the respiratory organs in these towns, whichhad been 172 and 156 in the two preceding weeks, furtherdeclined to 134 last week, and were slightly below thenumber in the corresponding period of last year. Thecauses of 23, or more than 3 per cent., of deaths in theseeight towns last week were not certified.

HEALTH OF DUBLIN.

The death-rate in Dublin, which had been 31°2, 35’2, and36’4 per 1000 in the three preceding weeks, declined againto 28’9 during the week ending April 7th. During the pastfour weeks the death-rate in the city has averaged 32’9 per1000, the rate during the same period being 20’4 in Londonand 22’6 in Edinburgh. The 194 deaths registered in thecity during the week under notice were 50 less than thenumber in the preceding week, and included nine whichwere referred to the principal zymotic diseases, againstnumbers declining from 12 to two in the five precedingweeks ; of these three resulted from measles, three from

whooping-cough, three from " fever," and not one eitherfrom small-pox, scarlet fever, diphtheria, or diarrhoea.These nine deaths were equal to an annual rate of 1-3 per1000, the zymotic death-rate during the same period being2-0 in London and 1’0 in Edinburgh. The fatal cases ofmeasles rose during the week to three, none having beenregistered in either of the two preceding weeks. The deathsreferred to whooping-cough increased to three, against onlyone death from this disease in the six preceding weeks. Thethree fatal cases of "fever" showed an excess of two overthe number in the preceding week. The 194 deaths inDublin included 23 of infants under one year of age and64 of persons aged 60 years and upwards; the deaths ofinfants and of elderly persons showed a decline from thenumbers recorded in the preceding week. Four inquestcases and two deaths from violence were registered, and 65,or one-third, of the deaths occurred in public institutions.The causes of 14, or more than 7 per cent., of the deathsin the city during the week were not certified.The death-rate in Dublin, which had been 36’4 and

28’9 per 1000 in the two preceding weeks, rose again to 34’3during the week ending April 14th. During the past fourweeks the death-rate in the city has averaged 33 7 per1000, the rate during the same period being 2l’Q inLondon and 23 in Edinburgh. The 230 deaths registeredin Dublin during the week under notice were 36 in excess ofthe number in the preceding week, and included six whichwere referred to the principal zymotic diseases, against twoand nine in the two preceding weeks; of these, two resultedfrom measles, two from "fever," one from whooping-cough,one from diarrhoea, and not one either from small-pox, fromscarlet fever, or from diphtheria. These six deaths were

equal to an annual rate of 09 per 1000, the zymoticdeath-rate during the same period being 1-8 in Londonand 1’0 in Edinburgh. The two deaths referred to measlesshowed a :decline of 1 from the number in the precedingweek. The fatal cases of " fever," which bad been one andthree in the two preceding weeks, declined again last weekto two. The mortality from whooping-cough was also lessthan it had been in the previous week. The 230 deaths inDublin last week included 34 of infants under one year ofage and 63 of persons aged upwards of 60 years; thedeaths of infants exceeded the number in the precedingweek, while those of elderly persons showed a slight declineNine inquest cases and nine deaths from violence were

registered, and 82, or more than a third, of the deathsoccurred in public institutions. The causes of 18, or nearly8 per cent., of the deaths in the city last week were not

certified.